Thursday, September 26, 2013

Roy was one of at least 40,000 Americans who took their own lives
that year and the next, the two-year span (1937-1939) that suicide rate spiked to
its highest recorded level ever: more than 150 per 1 million annually.
They are forgotten people, mostly men, and mostly brushed out of
existence by a generation preoccupied by World War II and the post-war
boom. Three-quarters of a century after Roy’s death, I sat across from
an old family friend, a woman in her 90s, who was eager to share stories
of that monumental past – except when it came to my great-grandfather.
When I finally asked her point bank if she had known him, her blue eyes
focused.

“He killed himself, didn't he?” she asked, but it was more of a
statement than a question. “Every family had a story like that. We never
spoke of them. Why would we?”

While those of us who read and study suicide know that the highest levels ever recorded were during the Great Depression, what is surprising about this article is the level of shame and almost denial many families were in then and are still in today about the people (mostly men) who killed themselves during that era. And how in many aspects, not much has changed today.

As I began to look deeper into the story, I carried a couple of
assumptions with me. First, I assumed there were likely to have been
previous suicide attempts. Second, that Roy’s suicide was linked to the
economy. Neither assumption is correct enough, as I learned by talking
to Alan Berman, the executive director of the American Association of
Suicidology. People see being suicidal as a long-term state of mind, but
most people who survive a suicide attempt do not later die by suicide.

Being suicidal is better understood not as a permanent state but as an
acute mental crisis. In the cases of public suicides the people
committing the act are probably in the grip of magical thinking.
“They think, ‘I will get attention in a world where I am feeling not
attended'. What becomes magical is that they are dead; they will never
feel attended,” Berman said.

An article I read brought this point home. The handful of people who
survived the leap from the Golden Gate Bridge told interviewers that as
soon as their feet left the bridge, they regretted the act.

I wrote about the article he mentions more than five years ago in this post.

My second assumption, that “the economy,” had somehow triggered Roy’s
act, was not specific or concrete enough. When it comes to understanding
suicide (or maybe anything), specificity is important.

Detailed studies of individual cases, or “psychological autopsies,”
might help researchers draw conclusions about causes, but autopsies have
not been done in large enough volume. So correlations are the best we
can do, but they need to be as specific as possible. Suicide is not
strongly correlated to the economy, but to unemployment. In the modern
era, for every 1 percent increase in the unemployment rate, there has
typically been an increase of about 1 percent in the number of suicides,
according to Steve Stack, a professor at Wayne State University.

Men still, more than women, define their self-worth by how much money
they make and their occupations. That partly goes to explain why the
suicide rate is three times higher among men than women.

Stigmas, of course, only have the power we give them. The stigma of
unemployment helped send Roy and thousands of other forgotten men to
their deaths – and still has an effect today. The suicide rates have
spiked again following the onset of the Great Recession, rising to 124
per million in 2010 from 115 per million in 2007. The stigma of suicide
is in effect, too: Some of those people will be forgotten.

Of course. In that sense, the stigma, shame, and guilt that is associated with suicide hasn't changed in 75 years. Or maybe ever.

On the numbers, while it is true that suicides have risen (both in real numbers and in rates) since the Great Recession began, it should also be noted that rates of suicide were rising before 2008 as well (up over 30% from 1999-2010). The author is half-correct in saying that suicide isn't tied necessarily to the economy, but I think it's a misnomer to assume that unemployment accelerated what was already an upward trend in suicide to begin with. As I pointed out in this post in May, suicide is up in age and various other demographic groups across the board (those too young or too old to work, among military veterans, the middle age, etc.).

We also need to be careful about assuming the "official" statistics are in fact just that. There are correlations to unemployment and economy, certainly, but no causal evidence.

Nonetheless, the point made by Alan Berman is sobering. Suicide is not a "long-term" state of mind, but in fact a very short, sharp reaction to an acute mental or social crisis (unemployment, divorce, rejection, and so forth). As Berman notes, almost every interview we have with people who have attempted suicide shows an extreme "remorse" about their actions and most will not eventually try it again or die by suicide. As the article from five years ago chillingly noted, almost from the moment people jump over the edge, there is instant regret at the decision.

In that sense, the cliche still stands: suicide is a permanent solution to a temporary problem. As Berman notes, when we can "head off the pathways to suicide" and buy people more time (by restricting access to guns, god forbid, or making it more difficult for people to jump) the more lives will be saved.

As it stands now, we are bordering on 40,000 suicides a year in the U.S., significantly more than die by auto accidents, AIDS or homicide. In fact, at 40,000+, we're getting into the range of cancer deaths.

And until we reconceptualize suicide as a cancer, we'll remain powerless to stop the epidemic.

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